Provider Demographics
NPI:1831250950
Name:CARRASQUILLO, VERONICA (RPT)
Entity type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:
Last Name:CARRASQUILLO
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 CALLE TABONUCO
Mailing Address - Street 2:VISTAS DE RIO GRANDE II
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-9766
Mailing Address - Country:US
Mailing Address - Phone:787-370-4520
Mailing Address - Fax:787-888-0867
Practice Address - Street 1:436 CALLE TABONUCO
Practice Address - Street 2:VISTAS DE RIO GRANDE II
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745-9766
Practice Address - Country:US
Practice Address - Phone:787-370-4520
Practice Address - Fax:787-888-0867
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1150225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR9500973OtherCRUZ AZUL COMPLEMENTARY
PR57236OtherRPT-SSS COMPLEMENTARY
PR57236OtherSSS MEDICARE OPTIMO
PR0057236Medicare ID - Type UnspecifiedPHYSICAL THERAPIST
PR57236OtherRPT-SSS COMPLEMENTARY